Final Study Flashcards
Risk factors for development of delirium include
Sensory deprivation/ isolation, sensory impairment, infection/ fever, presence of indwelling devices
b.
All of the above
c.
Functional impairment, polypharmacy, cognitive impairment, fecal impaction
d.
Dehydration, electrolyte imbalances and poor nutrition
e.
Anemia, hypoxia, uncontrolled Pain, urinary retention
Feedback
Best treatment for delirium
Prevention
C-Diff is a bacterial infection of the intestines causing diarrhea. A significant risk factor for developing C-diff includes a history of frequent use of what type of medication?
Antibiotics
Fall prevention Acronym SAFE
Safe environment: bedrails removed/down based on assessed need, clutter-free, brakes on, lights on.
Assist with needs: mobility, scheduled toileting, eyeglasses and aids, minimize restraints
Fall risk reduction
Engage residents and families
How is TB spread?
Droplet
Pain assessment tools
Body mapping
c.
Faces
d.
PAINAD
e.
Pain scale 0-10
Common side effect of most narcotic analgesics
Consitipation
What is Tardive Dyskinesia and what is it caused by (rhythmic, involuntary movement of the tongue, head, trunk, extremities, jaw, mouth)?
Adverse med effect
Annual screening test recommended for men
digital rectal exam
three different broad categories of treatment for cancer
Surgery, chemo and radiation
Palliative care is
Palliative care is specialized medical care provided to individuals living with life-limiting illnesses.
Example of an advanced directive
Living Will
Most common form of elder abuse
Financial taking advantage of
In what setting do older adults experience the most function decline
In what setting do older adults experience the most function decline
Health disparities
significant differences with regard
to the rates of disease incidence, prevalence, morbidity, mortality
or life expectancy between one population and another
4 different ways of defining age
Subjective
Perceived
Chroological
Functional
nurse’s questions addresses an important contributor to successful aging?
“Do you feel like you actively engage with life?”
SPICES (example)
Minimum Data Set (MDS) are examples of
Comprehensive Geriatric Assessments
Percieved age
Other peoples estimations of someone elses age
Older Indigenous Canadians are
More likely to live alone than any population
Which population is most strongly tied to low health status
Low socioeconomic status
3 components to successful aging
An active engagement with life, high
cognitive and physical function, and low probability of disease
and disability
The most common mental status assessment
Mini-mental state examination (MMSE)
Why are health assessments in older adults more complicated
It is common to have more than one chronic acute issue
Manifestation of illnesses or adverse medication effects tend to be obscure less predictable
For ever change there may be multiple possible causes
Treatments often directed at symptoms not source of problem,
Cognitive impairment affet accurate reporting
Geriatrics vs gerentology
Geriatrics is internal medicine focused on old people, a subset of gerentology, which is the study of aging as a whole
Cultural recognition and competence
Recognizing that clients from different cultures may have different customs and behaviours
and being sufficiently knowledgeable to interact with a member of that cultural with respect and understanding
Largest specific cultural groups in Canada
Asian Canadians and Indigenous
TUG acronym related to fall-risk
Timed UP and Go
Intrapersonal
Inside of person
Interpersonal
Between people
Stress
The sum of all effects of factors that act on the body
Three stages of stressors
Alarm, resistance, and exhaustion
*coping can come before stress
The better a person is a coping _____
The less impact stress will have on the body
How does the importance of spirituality change throughout life?
Increases as people age
Culture bound syndrome
A belief system can create a limit of acknowledgement of emotional/mental health
What percentage of adult Canadians do not have proficient health literacy
6/10 - especially ture of immigrants
What does level 1: primary spiritual care
Self awareness, assessing, compassionate presence, making referrals
What does level 2: spiritual care look like
Administration of religious rites, counselling etc.
Mini Mental status exam (MMSE) Assesses?
Assess 5 areas of cognitive function
Orientation
* Attention
* Memory
* Language
* Spatial-visual skills
Delusion, vs illusion, vs hallucination
Delusion: Fixed false beliefs
Illusion: Misperception of an external stimuli, have SOME basis in reality
Hallucination: Sensory experiences that have no external stimulus
Life Review
Form of psychosocial therapy
a progressive return to consciousness of past experiences, particularly unresolved
conflicts, for reexamination and reintegration.
If the reintegration process is successful, the process gives new significance and meaning to life and prepares the person for death by alleviating fear and anxiety
Confabulation
the process of
making up information,
Circumstantiation
involves the use of excessive details and
roundabout answers in responding to questions.
Executive Function
involves
an interrelated set of abilities that include cognitive flexibility,
concept formation and self-monitoring; but it does not
necessarily involve memory impairment
Leading cause of death in canada
Heart Disease
Coronary Artery Disease
CAD
When major blood vessels that supply the heart struggle to send enough blood O2 and nutrients to theheart muscle
Middle and thickett layer of heat wall
Responsible for pumping action
Myocardium
Age related changes to myocardium
Decreasing cardiac contractility
* More time is required for diastolic
filling and systolic emptying
* Less responsive to sympathetic
nervous system (fight or flight)
Less pacemaker cells
* Irregularity in the shape of
pacemaker cells
* Increased deposits of fat,
collagen and elastic fibers around
SA node
Age related changes to vasculature
Diameter of lumen of aorta
increases to compensate for
arterial stiffening
Veins, like arteries, become
thicker, more dilated, and
less elastic
* Increased vascular resistance
causes a slight increase in
the systolic BP
Why does left ventricle hypertrophy occur with ag
Increased peripheral resistance caused by changes to vasculature affecting flow to vital organs
Baroreflex mechanism age related changes
Decreased compensatory responses in both hyper- and
hypotensive stimuli (ie heart rate does not increase or
decrease as efficiently in older adults as in younger
adults)
Baroreceptors in the large arteries (carotid and aorta)
less effective in controlling BP, especially during
postural changes
Functional consequences of age-related changes to the cardiovascular system for the older adult?
Decreased adaptive response to exercise
* Slightly lower hear rate
* Increased susceptibility to hyper AND hypotension
* Increased susceptibility to arrhythmias (ie. atrial fibrillation)
* Decreased cerebral blood flow
Ventricular Fibrillation
An arrhythmia when lower heart chambers controcat in very rapid uncoordinated manner mean heart doesn’t pump blood to rest of body
Atherosclerosis
disorder of the medium and
small arteries in which deposits of lipids and atherosclerotic plaques reduce or
obstruct blood flow
Atherosclerotic changes begin in childhood and progress to plaque formation
Lesions can rupture or remain stable
Myocardial Infarction
Happens when one or more heart muscledont get enough O2 bc blood flow to heart is blocked
Definition of physical inactivity
Definition: <30 mins of moderate physical activity 5x/
week or <20 mins of vigorous physical activity 3x/ week
Non-smokers exposed to second-hand smoke increase their risk for developing CAD by
25-30%
High intake of _____ increases risk for CV
saturated fats
Number 1 Hypertensive risk factor
Hereditary
Hypertension risk factors
Age
ethnicity
heredity - NUMBER 1 thing
weight
physical inactivity
psychosocial stressors
sleep apnea
low education and socioeconomic factors
Metabolic Syndrome
Group of clinically identifiable conditions that double risk of CV disease and increases the risk of Non insulin dependent Diabetes Melitus
Dyslipidemia
A broad term of lipoprotein metabolism
* HDL cholesterol (good cholesterol) - good to have a
high number
* LDL cholesterol (bad cholesterol) - good to have a
low number
* Non-HDL cholesterol (total cholesterol – HDL
cholesterol) - good to have a low number
* Triglycerides - high reading is bad
What age related change results in Orthostatic and postprandial hypotension?
Changes to baroreflex mechanism
Numerical defintion of Orthostatic hypertension
Orthostatic hypotension is a reduction in 20 mmHg systolic or 10 mmHg diastolic within three minutes of standing after being recumbent for at least five minutes.
Postprandial Hypertension numerial defintion
a reduction in systolic BP of 20mmHg or more within 2 hours of eating a meal
Atypical SS of CVD
*Fatigue
* Nausea
* Anxiety
* Headache
* Cough
* Visual change
* Shortness of breath
* Pain in arm, jaw, neck or throat (vs
“typical” chest or shoulder pain)
The flu affects what body sysyems?
Systemic, paired with Resp illness
Age related changes affecting resp function
Degenerative structural changes in the nose
Diminished blood flow to nose
Thicker mucus in nasopharynx
Stiffening of trachea due to calcification of cartilage
Blunted cough and laryngeal reflexes
Atrophy of laryngeal nerve endings
Chest wall and musculoskeletal changes affecting resp function
Ribs and vertebrae become osteoporotic
- Intercostal cartilage calcifies and resp muscles weaken
Kyphosis
Chest wall expansion is compromised adn older adults need to expend more energy to achieve resp efficiency`
Age related changes to lungs
Become Smaller + more fatty
Alveoli enlage and walls thin = gradual increase in anatomic dead space
Pulmonary artery gets wider, thicker, and less elastic
# of caps decrease
Cap blood volume decrease
Mucosal bed, site of diffusion, thickens
Older adults breathe more or less?
More shallow breathing
Hypercapnia
Too much CO2
Systems stimulating breathing
Response to hypercapnia and hypoxia
Summary of age related changes to resp system
Summary of age related changes to resp
a
Increased stiffness of chest wall
Enlarged alveoli
Weaker respiratory muscles
Decreased response to hypercapnia or hypoxia
COPD
Chronic Obstructive Pulmonary Disease
Chronic obstruction interfering with normal breathing
Including both chronic bronchitis
(inflammation of bronchi) and emphysema (chronic progressive
lung disease)
Functional consequences of age related changes to resp system?
Increased susceptibility to resp infections
Frailty and dysphagia
Poor Oral Care
Aspiration Pneumonia
TB
Eats away at the tissue in the lungs
Lung tissue bleeds up through resp tract
Opportunistic illness
Pneumonia
An infection in one or both lungs causing alveoli to fill with fluid or pus making breathing difficult
Older adult symptoms of pneumonia
Present atypically in older adults
acute delirium/ confusion
◦ dizziness
◦lower than normal body temperature
(cold vs warm sepsis, with T < 36 C)
Difference bw endemic and pandemic
Endemic does not have an end
Symptoms of TB
Persistent coughing that lasts three or more weeks
Coughing up blood
Chest pain, or pain with breathing or coughing
Unintentional weight loss
Fatigue
Fever
Night sweats
Chills
Universal Falls Risk SAFE
Safe environment (5 safety checks)
Assist with mobility (mobilize at LEASSt BID)
Fall and injury risk reduction
Engage [ateint and family/caregivier
Osteoperosis
Porous Bone
When the body loses too much bone or does not make enough bone
Silent disease
High risk of bone fracture`
Damage to joints in RA is due to
Inflammation
Theory of multiple causation regarding OA
Infection, autoimmunity, genetic factors,
environmental factors, hormonal factors
Non modifiable risk factors for osteoperosis
Female gender
Caucasian race
Northern European ancestry
Advanced age
Family history of
osteoporosis
Previous fragility and > 40 yrs
of age
Most common type of arthritis
RA
Synovitis
(congestion/edema of
synovial membrane and joint capsule)
1st stage of RA
Pannus Formation
2nd stage of RA
(thickened layers of
granulation tissue that covers and
invade cartilage, destroy the joint
capsule)
Fibrous Ankylosis
(fibrous invasion of
the pannus and scar formation that
occludes joint space)
3rd Stage of RA
4th stage of RA
Calcification of fibrous tissue (total
ankylosis, immobilizing the joint)
Ankylosis
RA is ___ times more common in women
2-3 times
Difference bw OA and RA
OA: Bone ends rub together bc of thinned cartilage (Asymmetrical effect, weight bearing joints)
RA: Swollen inflamed synovial membrane and bone erosion (Symmetrical symptoms, occurs at younger age)
What is specific abt arthritis tylonel
Slow release
Parkinsons Disease characterized by
Tremor
Rigidity + stooped posture
Bradykinesia (slow movement)* Hypophonia (lowered voice
volume)
* Micrographia (small, cramped
writing)
* Pain
* Depression and dementia are
common comorbidities
What is unique abt PD meds “Wearing off effect”?
Parkinsons meds have short half life and thus are prescribed close together
Since there are intact neurons usually during parkinosns, the wearing off effect can be sudden and cause great anxiety to clients
Conductive hearing loss
Breakdown of parts of the inner ear
Ototoxicity
An adverse med effect involving hearing loss
Cataracts can cause
Sensitivity to glare
Double vision
Halos
Diminished colour perception
Dim and blurred vision
Characteristic and cause of Glaucomoa
Loss of peripheral vision
Cortisol steroid use, danger of diabetes
NSAIDs and anticholernergics are a risk of causing
Vision side affects
Mac degen
Loss of central vision
Blurred Vision and wavy lines
Meds that can affect gustatory function and olfactory and cause dry mouth
ACE inhibitors and diuretics
Xerostomia caused by
Decreased salivary production
Are use of dentures a nutriotional danger
If they are not fitted properly or missing there is a risk for nutrioitonal defficiency
Stress incontinence
Leakage of urine under activities that increase interdominal pressure
Benign prostatic hyperplasia symptoms
difficulty starting urination and a weak urine stream, frequent nocturia
UTI risk factors
Age
Catheter
Urinary incontinence
Age related changes to urine system
Increased production of urine at night
Impaired calcium absorption related to renal funciton
Kidneys help with activating vit D
Vit D helps with absopriton of calcium
When there is less Vit D, cannot absorb calcium
Kidneys become less effective with age, and therefore cannot manage calciumas well
Pelvic floor disorder
Sensation of pressure in pelvis resulting in flulness feeling and incontinence
Age related changes to myocardium
Increased time for diastolic filling
Decreased cardiac contrallity
Aorta lumen with age
Increases
What happnees to entothelial cells with age invasculature
Become irregularlly shaped
Barorecpters involved
in BP regulation
Register fight/flight
…
Which Cholesterol is good
HDL
High LDL associated with increased risk of heart disease
HDL puts bad cholesterol where it belongs
Alveoli enlarge and thinner with age true or false
True
Anticholinergics side affect
Dry mouth and upper airway
Sacropenia
Decreased muscle mass
PD gait
Reduced arm swing
Shuffling gait
Propulsion gait
Tobacco smoking affects mobilitiy how
Affects lungs and response to activity
Basal Cell Carcinoma arises from which layer of skin
Stratum basal
Squamous cell carcinoma looks like
Scaly red papulles and nodules usually on face and neck
Sleep affect by age
More light sleep, lesss deep sleep
Temp regulation affected by age why?
Decreased peripheral circulation
Risk factors decreasing sexual fuction
Societal attutudes
Adverse effects of meds
Functional impairments and chronic illness
Stage 3 cancer
Has grown, but has not spread to distant organs
Distant organs is stage 4
Purpose of a wound dressing
Protects wound from microorganism contamination.
Correct.
b.
Provides a moist environment for the wound bed,
Correct.
c.
Aids in hemostasis.
Yes, this is why we apply pressure to a bleeding wound.
d.
Absorbs drainage and supports auto-lytic debridement.
Think about the consequences if drainage is not removed from the wound.
e.
Protects patient from seeing the wound (if perceived as unpleasant).
Correct.
f.
Physically supports the wound site.
Correct.
g.
Promotes thermal insulation of the wound surface.
Two types of tissue healing
Primary intention: The skin edges are approximated or closed and the risk of infection is low. There is little tissue repair required
Secondary Intention: In this type of wound healing there is loss of tissue which must be filled with scar tissue. Chance of infection is greater.
Proliferation phase of wound healing lasts
3-24 days
A description of a hydro-colloid dressing is:
A dressing that forms a gel that interacts with the wound surface.
1 tbsp
15 ml
Examples of types of meds administered by topical route?
Ointments, Liniments, Lotions, Pastes, Transdermal discs or patches
What should the nurse do to maximize the effectiveness of medicated lotions or ointments?
First wash area with nondrying soap and water
Good habit when working with nitrate patches
It is recommended that nitroglycerin transdermal patches be removed after 10 to 12 hours to allow for a nitrate-free interval.
Application of a skin barrier cream to the perineal area can or cannot be delegated to NHCP?
Can
Standard IM injection needle size
22 G 1-1.5 “
3 signs of UTI
Cloudy +foul smelling urine, abdominal pain, and fever
An order is required to administer oxygen to a patient.
Yes
effluent
Stool discharged from an ostomy
When pouching an ostomy and cleansing the peristomal skin, a good vigorous scrub with soap and water is required to remove any bacteria or stool residue from the skin. T or F
False
Is dehydration a risk accosiated with suctioning a patient?
No
The earliest indications of IV fluid infiltration include:
Pallor and coolness
Nurses assess the IV site and fluid administration every ________ hours.
Every Hour
When a patient’s IV site has marked erythema and pain, it is called:
Phlebitis
_________ occurs when IV fluids enter the surrounding space around the venipuncture site.
Infiltration
Normal saline as an IV Fluid is also known as
0.9% NS
a crystalloid
d.
NaCl
e.
sodium chloride
One of the most common electrolyte imbalances is:
Hypokalemia
Low potassium
Mr Frank is an 82 year old patient who has had a three day history of vomiting and diarrhea. Which symptom would you expect to find on a physical examination?
Tachycardia
Successful Aging
an active engagement with life, high
cognitive and physical function, and low probability of disease
and disability
Stages of change
Pre-contemplation: Denial
Contemplation: Intention to change bc of acknowledgement of negative consequences
Preparation: Strong inclination to change to healthier behaviour
Action: Behaviour change is made
Maintenance: When health behaviour has been continued for greater than 6 months
Skilled home care vs nonmedical home care
Skilled home care services address
the needs of people who are recovering from an illness or
injury and have potential for returning to their previous level
of functioning. In contrast, nonmedical home care services
address needs of people with chronic or declining conditions
who do not qualify for skilled care.`
To qualify for skilled care in a nursing home, people
must meet the following THREE criteria:
Have a medical condition that is associated with the need
for skilled care
e Have a physician referral for services that must be provided
by licensed professionals, such as nurses or therapists
® Require daily skilled care that can be provided appropriately
in a skilled nursing facility
pharmacokinetics
how the drug is absorbed,
distributed, metabolized and excreted
pharmacodynamics
how the body is affected by the drug at the
cellular level and in relation to the target organ).
Elimination half-time
is the
time required to decrease the drug concentration by one half
of its original value. It takes five half times to reach steadystate
concentrations after a drug is initiated or to completely
eliminate a drug from the body after a drug is discontinued.
It takes ____ half times to reach steadystate conc. after drug is initiated or to completly eliminate drug from body
5
Clearance Rate
measures the volume of blood from
which the drug is eliminated per unit of time.
Major age related change affecting medication clearance rate
Decrease GFR
Beers Criteria
medications are deemed
inappropriate if they are ineffective or have poor safety
profiles, or if better drugs are available in relation to older adults
anticholinergic
adverse effects
Many OTC agents commonly
used for coughs, colds and sleep problems contain
anticholinergic ingredients.
anticholinergic agents have been identified as
a causative factor for significant and long-term cognitive
impairment in older adults, including delirium and mild
cognitive impairment
Tardive dyskinesia
a constellation of rhythmic and
involuntary movements of the trunk, extremities, jaw, lips as a result of antipsychotic medication
Medication Reconciliation
the process of identifying a patient’s
medication errors, such as omissions, duplications, dosing
errors or drug interactions during transitions in care. The
three steps involved in the process follow: (1) verification
by collecting an accurate list; (2) clarification of questions
about drugs, dosages, frequency and other pertinent information
and (3) reconciliation of any discrepancies
Learned helplessness
the experience of uncontrollable
events that leads to expectations that future events
will also be uncontrollable.
Executive function
multifaceted and involves
an interrelated set of abilities that include cognitive flexibility, concept formation and self-monitoring; but it does not necessarily involve memory
Executive function deficits begin in the early stages of dementia (difficulty with abstract thought)
affective function.
refers to his or her
expressions of emotions, particularly facial expressions of
underlying emotions.
CAM
Confusion assessment method
- Diagnosis tool for delirium
1 Acute onset/fluctuating course
AND
2 Inattention
AND ONE of:
3 Disorganized thinking
4 Altered LOC
Anosognosia
Anosognosia,
which is the diagnostic term for lack of awareness, is assessed
by having the person who is being evaluated and a
family member or caregiver independently answer questions
related to the person’s behaviours and daily activities
Distinguishing characteritistcs of delirium
Acute
Sudden
Temporary
Preventable
Treatable
PD is what type of dementia?
Lewy body
AD is caused by
Plaque in the brain
Pharm approach to dementia
Cholinesterase inhibitors
Slow drug clearance in oldr adults related to
increased body fat
Decreased lean muscle
Decreased body water
Reduced hepatic blood flow
Decreased serum albumin
Otosclerosis
is the sensorineural hearing loss associated
with an abnormality of the auditory structures - associated with younger age hearing loss
Presbycusis
is the sensorineural hearing loss associated
with an age-related degeneration of the auditory structures.
health care proxy (
responsible for communicating
the person’s wishes if he or she becomes incompetent
or unable to communicate them.
Which layer of the heart is associated with hypertension
hypertension
Ductectasia
Enlargement of the aveoli
Ostopenia
Milder osteoperosis
Which medication is a risk for fall relatd injuries
Anticoagulants
Anticholinergics
Chronic pain length
Lasting 3-6 months longer than expected healing time
PAINAD (stands for)
Pain assessment in Advanced Dementia
AND
Allow Natural Death
Most common type of elder abuse
Financial exploitation and emotional abuse
- When using the PAIN-AD for assessing pain in patients with Advanced Dementia, what are two of the five items being assessed?
a. Breathing (labored breathing, long period of hyperventilation)
b. Negative vocalization (moans, crying, negative low voice speech, repeatedly calling out)
c. Facial expressions (flat affect, grimacing, confused look, change of demeanor, etc.)
d. Body language: (tense, fidgeting, pacing, fist clenched, pulling away) *
e. Consolability (Can you console or not?)
0, 1 or 2 (0 being normal/baseline, two be Always)
Non-Opioid Analgesics typically better for what type of pain
Bone and inflammation
Adjuvant Analgesics
Medication that have a primary indication
other than treatment of pain but relieve pain in
some conditions.
Caffiene helps relieve pain IN the presence of acetiminaphin
- What assessments are critical to perform when evaluating the effect of a narcotic analgesic?
Sedation + VS
POSS Scale is?
Pasero Opiod induced Sedation Scale
PACSLAC
Pain Assessment Checklist for Seniors with a Limited Ability to Communicate
S/S at end of life
Altered breathing patterns:
Changing circulation:
Decreased muscle tone:
Decreased senses (except hearing)
